Lords Taverners NNSW | » APPLY FOR AN ADAM GILCHRIST CRICKET SCHOLARSHIP

APPLY FOR AN ADAM GILCHRIST CRICKET SCHOLARSHIP

APPLY FOR AN ADAM GILCHRIST CRICKET SCHOLARSHIP:
by (a) downloading this form and forwarding it: Adam S’Ship Appl Form

or by completing the form below and submitting it:

Full Name*
First Last
Date of Birth (Day/Month/Year)*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Home Phone*
Mobile*
Email for contact*
I wish to make application for the award of an Adam Gilchrist Cricket Development Scholarship. I have examined the Rules and Conditions Statements, and agree to be bound by these. I have requested that a report from my current coach be emailed to you, and I have detailed other relevant information for the Selection Committee below:*
Name of my current coach*
First Last
Email of my current coach*
My Home Club in Australia*
Name of Secretaery*
First Last
Address of Secretary*
Street Address City State / Province / Region ZIP / Postal Code
Preferred Phone of Home Club Secretary
Email of Secretary of Home Club*
Name of Personal Referree*
First Last
Preferred Phone of Personal Referee*
Referee's connection with me:*
List of my best cricket performances in the last two years. (If space prevents full information, please email or post further details)*
Year Team Played for Team against Performance
I already hold the following Cricket Coaching Accreditation:*
Knowing that the scholarship encompasses matters other than my cricket ability, I wish to draw your attention to the following contributions that I have made to my school, local community or to cricket in general:*

Year	Team Played for	Team against	Performance